Therapy | Stomach cancer therapy

Therapy

The treatment of patients requires intensive cooperation between the specialist in surgery, internal medicine, radiotherapists and pain therapists. During the therapy, the TNM classification is used as an essential decision-making aid. There are corresponding therapy guidelines for each tumor stage.

Thus, three treatment goals can be described, which are considered depending on the stage. The only chance of cure for the patient is to radically remove the tumor, i.e. to operate out of the tumor in its entirety (R0-resection), which is only possible in about 30% of patients. Since stomach cancer is usually diagnosed and thus treated at a late stage, a total stomach removal (gastrectomy) must often be performed, which is always accompanied by a generous removal of the lymph nodes.

Often the large (omentum majus) and small net (omentum minus) and the spleen (splen) are also removed (resected). Depending on the location of the tumor, a distinction is made between different surgical techniques. Here, the surgeon has various options at his disposal to restore the continuity of the gastrointestinal tract and to reconstruct a connection between the remaining stomach and the subsequent intestine (anostomosis).

In some patients, the tumor process is very advanced, so that curative surgery can no longer be performed. However, there are many different operations available that can alleviate the symptoms (palliative therapy).The focus is on surgical techniques that ensure the passage of food. Tissue diagnostics The removed stomach tumor is evaluated microscopically (histologically) after removal.

For this purpose, the tumor preparation is incised at specific sites and at the edges of the resection. Wafer-thin incisions are made from these samples, stained and evaluated under the microscope. The type of tumor is determined, its spread into the stomach wall is assessed and those with removed lymph nodes are examined for tumor infestation.

To completely rule out lymph node involvement, the pathologist must examine at least 6 lymph nodes. Only after the tissue findings have been made can the tumor be clearly described according to the TNM classification.

  • Antrum carcinoma In the case of a tumor located in the stomach exit area, part of the stomach can be preserved if the tumor spread allows it.

    A 2/3 or 4/5 resection must be considered. In case of diffuse growth of the tumor, however, a total gastric removal (gastrectomy) is also indicated.

  • Corpus carcinoma Tumors located in the corpus (main part) of the stomach are treated with a radical stomach removal.
  • Cardiac carcinoma The tumor located at the entrance to the stomach is also removed by total gastric resection. The lower esophagus is also removed.

Radiotherapy is used for this type of tumor when the tumor is inoperable and does not respond to chemotherapy.

Radiotherapy cannot cure stomach cancer. Since stomach cancer is usually an adenocarcinoma (see above), it usually does not respond well to chemotherapy. Chemotherapy is therefore used, as with radiotherapy, as palliative therapy when there is no possibility of surgery.

Sometimes chemotherapy is also used to reduce the size of the tumor and thus make it operable (neoadjuvant therapy). If the nutritional pathways through the tumor are very severely constricted, the patient’s nutrition must be ensured by means of aids. To keep the food passage open, a plastic tube or a tubular wire frame (stent) must be implanted occasionally.

These surgical procedures can usually be performed minimally invasively during a gastroscopy. Laser therapy can be used as an alternative to a tube or stent. In this procedure, the laser vaporizes the parts of the tumor that obstruct the passage of food, thereby reducing the amount of esophageal or gastric volume.

Unfortunately, the tumor often grows back from the underlying layers, so that the treatment sometimes has to be repeated after 7-14 days. If other therapy options to keep the food passage open fail, a tube, a feeding tube (PEG), can be placed directly through the skin into the stomach. This treatment method is a minor surgical procedure.

Under endoscopic control, a hollow needle (cannula) is first inserted through the skin and into the stomach, where a plastic tube is inserted as a permanent connection to the stomach. The PEG offers many advantages for the patient, in contrast to a gastric tube inserted through the nose: The patient can feed himself/herself through this tube (“astronaut food”). Compared to the nasal probe, the probe clogs less easily and more food can be fed at once. Another important point for the patient, however, is aesthetics, as the tube disappears under clothing, invisible to others.